Spain and Ebola: Discuss

[crazyoldboatguy]

I had not heard that the 2 ill nurses were from the staff who had treated the first patient ON HIS FIRST ADMISSION. Those staff members had not known he had Ebola at that point so would not have engaged in ANY infectious disease protocols, would they? The 2 RNs who became ill have been accused of "not following protocol". Why would they have been engaged in ANY protocol if they didn't know he had Ebola?

[transmitterdan]

He was not admitted the first time he came to the ER. The 2 ill nurses are from the second time he came to the ER but before he was tested for Ebola. They did not go into hazmat mode until the test results came back.

[robert sailor]

Ebola victims are most infectious towards end of life and much less so to begin with so the folks most often infected are health care workers. These people are very brave by anyone's standards and it amazes me how those in Africa work so hard under so much pressure. When this whole thing is over those medical workers should be rewarded in some way.

[BandB]

Originally Posted by transmitterdan

He was not admitted the first time he came to the ER. The 2 ill nurses are from the second time he came to the ER but before he was tested for Ebola. They did not go into hazmat mode until the test results came back.

A diagnosis of Ebola was made but instead of going into hazmat mode and treating it like an Ebola patient, they waited until they had confirmation back from the lab results that it was Ebola.

As a lesson learned, when Baylor had a similar situation they immediately began to treat the case as if Ebola. That patient I believe has now been transferred to Dallas Presbyterian.

Very poor judgement when he was admitted. What should happen the moment you think someone could possibly have Ebola you go into the full plan doing everything on the assumption they do. Then if it turns out otherwise, you relax at that time.

[Delancey]

Attached - Ebola virus disease (Ebola) evaluation algorithm — New York City Department of Health and Mental Hygiene (DOHMH), September 3, 2014.

The recent report below indicates that there were delays in diagnosis in suspected cases in NYC prior to October 6th because "of hesitancy by health care providers to examine patients or by laboratory workers to handle specimens" as in people recognized what they were potentially dealing with and said "no way, I'm not capable of safely handling this, you have to get someone else."

http://www.cdc.gov/mmwr/preview/mmwr..._cid=mm641a5_w

BTW, according to the CDC the United States is now an Ebola-affected area (country), along with Spain, Nigeria, and Senegal. Have you traveled in the US in the past 21 days?

http://www.cdc.gov/vhf/ebola/outbrea...ution-map.html

[atoll]

Originally Posted by BandB

A diagnosis of Ebola was made but instead of going into hazmat mode and treating it like an Ebola patient, they waited until they had confirmation back from the lab results that it was Ebola.

As a lesson learned, when Baylor had a similar situation they immediately began to treat the case as if Ebola. That patient I believe has now been transferred to Dallas Presbyterian.

Very poor judgement when he was admitted. What should happen the moment you think someone could possibly have Ebola you go into the full plan doing everything on the assumption they do. Then if it turns out otherwise, you relax at that time.

it won't be long before ER rooms are pressurised and the public are vetted on the other side of a glass screen until cleared for ebola.......a bit like going to the bank but with UV lighting..
come winter vomiting flu

[crazyoldboatguy]

transmitterdan, thank you for clarifying - I had misunderstood your post.

So, this man had come back to the hospital quite ill, copped to having been in contact with someone with Ebola, has the qualifying symptoms, and the hospital waits to engage in proper protocol until the test confirms the diagnosis? The RNs likely followed the directions of their superiors, like the second RN who CALLED THE CDC MORE THAN ONCE, told them she had had contact AND had a fever and the CDC told her it was OK to fly.

If these are the folks in charge, the folks we have to rely on to protect the health of the US citizens, we are screwed.

However, in the autocratic state of Nigeria, thinks are coming along nicely.....if you want to be kept safe from Ebola. Even Boko Haram sounds like they may release some of the over 200 girls kidnapped. Ransom paid?

[SaltyMonkey]

I predict the Nigeria strain is dormant and will rise its ugly head again in three to four weeks.

What happens if it mutates to be able to survive in mosquitos, or warm-plants?

[crazyoldboatguy]

Apparently, Ebola is remarkably unchanged in the 40 years since it first appeared. This is one reason why some feel it is not likely to mutate into an airborne disease.

That should make a vaccine easier to create. Makes you wonder why it hasn't been? The reason is that in order to test efficacy, blind studies should be done. That raises ethical concerns in that those who get the placebo are likely doomed to a painful death when finally exposed to the virus.

It appears the plan is to move forward with the most likely vaccine now in development - to administer it directly to the populace in the epicenter of the outbreak and see what happens. Earliest time for that would be sometime early next year, according to the WHO.

[atoll]

Caribbean for Xmas..........maybe not................

https://uk.news.yahoo.com/guyana-hal...4.html#OH1aMTw

KINGSTON, Jamaica (AP) — Jamaica, Guyana and Trinidad & Tobago on Thursday became the latest countries in the Western Hemisphere to restrict travelers from West African nations struggling with an epidemic of the Ebola virus.

The announcements came a day after Colombia and St. Lucia ordered similar prohibitions.

Authorities in Jamaica imposed an immediate entry ban on anyone who has been in Guinea, Liberia and Sierra Leone within four weeks.

The ban was announced shortly after a U.S. couple was quarantined at Sangster International Airport in the northern tourist town of Montego Bay. Airport screeners found one of the Americans had been in Liberia two weeks ago. Officials said the couple was kept in quarantine, found to be healthy, and then sent back to an unspecified city in the U.S.

Guyana's government said that country's diplomatic missions had been directed not to issue visas to people from West African nations affected by the virus.

Trinidad & Tobago said it would deny entry any resident of Guinea, Liberia, Nigeria, Democratic Republic of Congo or Sierra Leone. Other travelers who have visited any of those nations within six weeks will be quarantined for 21 days upon their arrival.

[Kenomac]

Apparently, all that an ISIS fighter needs to do to bring the US Pentagon to it's knees is to vomit in the parking lot.


Ebola scare at Pentagon after woman vomits in parking lot

By Phil Stewart 38 minutes ago


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Emergency workers in hazmat suits work in a Pentagon parking lot after a woman who recently traveled …





By Phil Stewart



WASHINGTON (Reuters) - The Pentagon was gripped by an Ebola scare on Friday after a woman vomited in a parking lot, triggering authorities to send in a HazMat team and shut off part of the military complex before concluding she did not have the deadly virus.
The Pentagon initially said in a statement that the woman indicated she had "recently visited Africa."
But her employer told Reuters she had not traveled abroad recently and local county health authorities later acknowledged that her travel history had been uncertain.
"Based on the public health investigation, which included the travel history of a woman who became ill this morning in a Pentagon parking lot ... medical authorities are confident that she does not have Ebola," the local health authorities said in a statement.
The public health investigation also included questioning of the woman by medical staff, they said.
View gallery

Emergency workers in hazmat suits work in a Pentagon parking lot after a woman who recently traveled …

There has been mounting alarm in the United States about the risks from Ebola after two nurses who cared for an Ebola patient in Texas contracted the virus. Ebola has killed more than 4,500 people, mostly in West Africa.
The incident outside the Pentagon triggered emergency protocols. The Arlington County Fire Department sent emergency medical aid and a HazMat response team, and the Pentagon closed down part of the parking lot and one of its entrances.
Since the woman had briefly boarded a bus before falling ill, the vehicle and its passengers were stopped for about four hours, one passenger recounted to Reuters. The passengers included uniformed Marines headed to a Marine Corps ceremony attended by top brass and U.S. Defense Secretary Chuck Hagel.
The Pentagon later said the passengers were being screened.
"An investigation of this person and her illness led investigators to believe at the time that they were potentially dealing with a person with an infectious disease," it said.
(Reporting by Phil Stewart; Editing by Mohammad Zargham, Frances Kerry and Ken Wills)

[transmitterdan]

Both times the index patient came to the ER he fully disclosed he was from Liberia and intake staff recorded it on his chart. The first time his symptoms weren't severe and the attending did not read the travel history on the chart. The second time they did not "diagnose" Ebola but they suspected. The lab tests confirmed. Everyone knows they should have isolated even a suspected Ebola patient. That's a lesson learned. But prior to this the same thing could have happened at any busy ER.

[BandB]

Originally Posted by transmitterdan

But prior to this the same thing could have happened at any busy ER.

Could have but should not have. The first time the travel from Liberia should have thrown up a red flag, the doctor should have noticed the chart, and any conversation with the man based on accent should have led to the question. Still the first time many would have perhaps missed it. But at 3:02 AM the patient's temperature had risen to 103 degrees and that was already on their first dosage of Tylenol. That was a rise of 3 degrees in 3 1/2 hours. The EHR with the travel history was referenced by the physician many times but still he apparently didn't read that part.

Now the patient did lie to the physician and say he had not been with sick people. The same lie he gave in leaving Liberia when he had just been with someone who died from Ebola. Now the travel history was not asked for by the Triage nurse, not until the RN asked for it two hours after the patient arrived. They then had a long discussion of it, talking about how long the flights were. So the first time the physician looked at the EHR it was not there, but was prior to examination. The RN attached no significance to the travel history.

I will say the first time also reflects general poor handling of infectious diseases in Emergency rooms. The patient was there 5 hours and given discharge papers saying to see another physician "tomorrow" which was now today. They react strongly to heart problems and to bleeding. I know of a very recent case of an 85 year old woman spending an entire night in ER with them looking for heart problems but no one did a simple urinalysis when all the symptoms were consistent with a UTI which is very common in women that age. After 9 hours, they were ready to dismiss her with no diagnosis until her daughter told them what to do. Result, UTI. They then sent her home and three days later she was admitted in more serious condition.

I will also say that none of the labs from the first visit indicated anything extreme. Several tests were out of range and AST (liver damage) was about 3 times normal range but that is still not cause for alarm as it can be 1000's of times normal.

However, the second time, it was actually diagnosed as Ebola subject to confirmation by labs. Much of the time a "clinical" diagnosis is made but confirmed either by labs or scans depending on the condition. You don't wait. We start treatments based on clinical diagnoses. The moment the word "Ebola" was first mentioned things should have changed dramatically. The very act of sending slides to the CDC tells you to treat it as Ebola until proven otherwise.

Now, this is all an important lesson, not just for Ebola. It is not the only infectious disease. Just has one of the worst survival rates. But there were a lot of seniors who died from H1N1 when it first hit because ER's (and other physicians) did not react strongly enough.

[SaltyMonkey]

Originally Posted by crazyoldboatguy

..
That should make a vaccine easier to create. Makes you wonder why it hasn't been? The reason is that in order to test efficacy, blind studies should be done.

No the real reason is that it's not cost-effective enough for manufacturers to bother, just as its not cost effective to go after drug resistant TB.

[sneuman]

Anyone see this?! Man Infected with Ebola Misinformation Through Casual Contact With Cable News - The New Yorker